State ex rel. Perez v. Indus. Comm’n – Overpaying Benefits

The goal for most injured employees collecting workers’ compensation is to eventually return to work. However, doing so can have consequences for your benefits. That’s why it’s important to consult with your lawyer before returning to work.

In addition to the coverage of medical bills, workers’ compensation benefits in Georgia are supposed to cover a portion of wage losses if a person is unable to work for a time. Even if that person returns to work, they may still collect some of those benefits – but only if they are earning less than they did before as a result of their disability.

A worker who earns more than they did before while still collecting benefits may find themselves running afoul of the system. Take for example the recent case of State ex rel. Perez v. Indus. Comm’n, a case recently weighed by the Ohio Supreme Court.

Plaintiff was accused of being overpaid his temporary total disability benefits – and committing fraud in applying for it – when he collected workers’ compensation benefits while continuing to operate his auto repair business. He had reportedly represented to the state commission that he had not worked since 2003 to 2011. However, evidence suggested he was operating his auto repair business and still collecting workers’ compensation benefits from 2007 through 2011.

Plaintiff was injured while working in the construction industry in 2002. He filed a claim for workers’ compensation benefits, citing neck sprain, lumbar sprain, bulging and protruding discs, cervical spondylosis, major depression and cognitive disorder. He was awarded temporary total disability benefits on numerous occasions.

In 2007, he began receiving benefits solely based on his psychological conditions.

Before his injury in 2002, plaintiff owned and operated an auto repair business in the first floor of a building. He lived on the second floor. In 2011, the Bureau of Workers’ Compensation got word he was operating his auto repair business while still collecting workers’ compensation benefits for his earlier injuries.

A special investigations unit inquiry was launched. That inquiry was closed in 2012 when investigators concluded that while he was working, there was no evidence he was being paid for that work.

A new investigation was launched later that same year based on new information and that resulted in a recommendation to the state commission that there be a finding of over-payment of benefits and fraud. The commission agreed. Worker appealed, and the appellate court found that while he had been overpaid, he hadn’t committed fraud.

The Ohio Supreme Court affirmed in part – finding he had been overpaid – but reversed the appeals court finding on the fraud, finding fraud had been committed.

The court further concluded the worker had more than just a minimal involvement, based on the fact that he was observed physically performing auto repair work on a tractor, meeting with customers and discussing auto issues with them. Some customers testified that they had worked exclusively with the worker in question and that he represented to them that he was the one who would be doing the work. He also scheduled appointments, diagnosed vehicle problems and handled payments.

The worker in this case argued that his activities were unpaid and minimal and therefore weren’t inconsistent with his continuing to receive temporary total disability benefits. The state supreme court disagreed.

This case reveals why it is generally a good idea to have an attorney on your case at the outset. Someone who understands the ins-and-outs of your condition can help advise you of your best course of action if and when you want to try to return to work.